| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
45 |
45 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
18 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27 |
27 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
17 |
17 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
29 |
28 |
$365.69 |
| 90461 |
|
16 |
16 |
$340.47 |
| 96127 |
|
20 |
20 |
$142.20 |
| 99173 |
|
43 |
43 |
$0.00 |
| 99401 |
|
21 |
21 |
$0.00 |